title: Heterogeneity of Brunsting-Perry type pemphigoid: a case showing blister formation at the lamina lucida, immune deposition beneath the lamina densa and autoantibodies against the 290-kD polypeptide along the lamina densa.
abstract: An otherwise healthy 31-year-old man presented with multiple, vesicular, subepidermal blistering on the head, face, chest and oral cavity, leaving shallow scar formation, typical of Brunsting-Perry type pemphigoid. Direct immunofluorescence showed linear deposition of immunoglobulin (Ig)G and C3 along the basement membrane zone (BMZ), and indirect showed anti-BMZ autoantibodies (IgG, >40×) reacting with the dermal side under the salt-split study. Immunofluorescence staining for type IV collagen and laminins, as well as routine electron microscopy, demonstrated that the cleavage level of the blister was intra-lamina lucida. The immunoperoxidase method applied to lesional skin demonstrated IgG deposits along the lamina densa. The post-embedding immunogold method demonstrated that the autoantibodies against BMZ reacted with the lamina densa and the dermis just beneath it. Immunoblot studies demonstrated that the autoantibodies reacted with the 290-kD polypeptide (suggesting type VII collagen) when dermal extract was used as the substrate. The patient was treated with combination therapy consisting of 30 mg prednisolone, 900 mg nicotinamide and 750 mg tetracycline, and the number of newly forming blisters decreased. We concluded that Brunsting-Perry type pemphigoid, a rare autoimmune blistering disease, includes cases showing characteristics of epidermolysis bullosa acquisita as well as bullous pemphigoid. This case showed discrepancy between the blistering level (intra-lamina lucida) and location of antigen (lamina densa and sub-lamina densa areas).
authors.affiliation: Department of Dermatology, Osaka Red Cross Hospital, Osaka, Japan.
authors.forename: Haruka
authors.initials: H
authors.lastname: Minato
authors.forename: Norito
authors.initials: N
authors.lastname: Ishii
authors.forename: Shunpei
authors.initials: S
authors.lastname: Fukuda
authors.forename: Tomoko
authors.initials: T
authors.lastname: Wakasa
authors.forename: Ken'ichi
authors.initials: K
authors.lastname: Wakasa
authors.forename: Ryosuke
authors.initials: R
authors.lastname: Sogame
authors.forename: Takashi
authors.initials: T
authors.lastname: Hashimoto
authors.forename: Yuji
authors.initials: Y
authors.lastname: Horiguchi
mesh_terms: D000328:Adult; D001323:Autoantibodies / Q000378:metabolism; D001324:Autoantigens / Q000378:metabolism; D001327:Autoimmune Diseases / Q000276:immunology / Q000473:pathology; D001485:Basement Membrane / Q000276:immunology / Q000473:pathology; D001768:Blister / Q000276:immunology / Q000473:pathology; D024143:Collagen Type VII / Q000276:immunology; D016107:Epidermolysis Bullosa Acquisita / Q000276:immunology / Q000473:pathology; D019085:Fluorescent Antibody Technique, Direct; D006801:Humans; D008297:Male; D016253:Microscopy, Immunoelectron; D010391:Pemphigoid, Bullous / Q000276:immunology* / Q000473:pathology*; D012872:Skin Diseases, Vesiculobullous / Q000276:immunology / Q000473:pathology
chemical_list: D001323:Autoantibodies; D001324:Autoantigens; D024143:Collagen Type VII